SPIRITUALITY: A FIELD OF GROWING IMPORTANCE IN PSYCHOLOGY

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Pharmacotherapy

People suffering from mild to moderate depression are more likely to benefit from psychotherapy than from pharmacotherapy (Beckham & Leber, 1985; Klerman & Schechter, 1982). However, there is a considerable body of research that antidepressant medication is effective as a treatment for major depression (Hollon & Beck, 1986; Mindham, 1982; Mulder et al., 2003; Noll, Davis, & DeLeon-Jones, 1985; White, 1982). John White (1982) suggests that there are some depressions
that respond only to pharmacotherapy, but opponents of the medical model, such as Michael White would dispute this (White, 1995). Cowen (2002) rightly rejects dualistic categories, stressing that an integrated treatment of depression on all levels appears to be the most successful.
Antidepressant medication influences the concentration of neurotransmitters at the nerve synapses, and is available in a number of varieties (Kaplan & Sadock, 1998). Stimmel and Aiso (2005) give a helpful summary of the evolution of anti-depressant medication. The earlier tricyclic antidepressants were distinguished by their broad mechanism of action, but also by their many undesirable side-effects. The next phase was the development of selective serotonin re-uptake inhibitors that acted more specifically, had fewer undesirable side-effects and were not fatal in overdose. Concern was raised, however, that the fewer side effects went hand in hand with less clinical effectiveness. As a result, multiple mechanism antidepressant drugs were developed that acted upon two neurotransmitters at the same time. For example, venlafaxine inhibits serotonin and norepinephrine reuptake. By a different mechanism mirtazapine also acts on serotonin and norepinephrine and selectively inhibits certain postsynaptic serotonin receptor subtypes primarily responsible for the gastrointestinal side effects and sexual dysfunction associated with earlier selective serotonin reuptake inhibitors (Stimmel & Aiso, 2005). These advances suggest that this method of treating depression is a promising one. The day of effective antidepressant medication with no undesirable side effects may not be far off (Bullock, 1996; Stimmel & Aiso, 2005).
It is the researcher’s view that anti-depressant medication, although helpful in many instances, may be prescribed too easily, and that the hard work of psychological growth is therefore sometimes avoided. It is worth quoting from Carson and Butcher (1992, p.408): “…modest distress or unhappiness should not be an occasion for taking drugs but for rigorously examining one’s life”. Indeed one could argue convincingly that, whereas in the past depression has served a relatively positive function by encouraging people to restructure their lives, or turn to God, or to find healing in poetry or song, the practice of instant medication to alleviate sad feelings may prevent psychological growth (Bullard, 2002).

Cognitive-behavioural therapy

Cognitive-behavioural therapy has clearly been demonstrated to be an effective means of treatment for unipolar, non-psychotic depression (Hawton et al., 1989; Kaplan & Sadock, 1998). The treatment is based largely on the work of Beck and his colleagues (Beck, Rush, Shaw, & Emery, 1979) although there are other theorists in the field, such as Ellis and his rational-emotive approach (Ellis, 1973). Beck suggests that early human experience can lead to the formation of dysfunctional cognitions (Beck, 1967). In the face of stress, these cognitions are activated and in turn lead to what Beck calls “negative automatic thoughts”, negative in that they are unpleasant, automatic in that they race around a person’s mind in an uncontrollable manner.
These uncontrolled thoughts lead to other symptoms of depression: behavioural symptoms (withdrawal, loss of energy), motivational symptoms (loss of interest), emotional symptoms (anxiety, guilt, feelings of worthlessness), cognitive symptoms (poor concentration, difficulty in making decisions) and physical symptoms (insomnia or hypersomnia, loss or increase of appetite). A vicious circle begins: more depression leads to more negative thoughts, which in turn lead to more depression (Beck, 1967; Hawton et al., 1989; Kendler et al., 2003).
The cognitive-behavioural therapist intervenes in the vicious circle by questioning automatic thoughts and challenging the assumptions on which these are founded. The more positive thinking pattern begins to lift the depressed feelings and a process of cognitive-behavioural restructuring takes place by education and the transferring of skills learned into the person’s environment through homework assignments (Beck, 1967).
The research shows as much support for the effectiveness of cognitive-behavioural therapy as for pharmacotherapy, especially for long-term follow up (Dobson, 1989; Kaplan & Sadock, 1998; Kendler et al., 2003). More recently, cognitive therapy produced a beneficial impact on the depression levels of rural, battered women (Zust, 2000). Over the last few decades, the cognitive component has virtually eclipsed the behavioural component, although recently there have been attempts to reinvigorate behaviourist therapy by a contextual examination of the external triggers of stress and the ineffectual coping methods used (Hollon, 2001).

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Psychoanalytical therapy

The theory and practice of psychoanalytic therapy has developed in many divergent and complex ways since its advent over a century ago, which makes it difficult to comment on its use and effectiveness as a treatment for depression. Freud (1914) suggested helpfully that any therapeutic approach that has two main features, namely transference and resistance, can be seen as psychoanalytic. Transference can be defined as the distortion of significant others in current experience in order to fit personality patterns and expectations deriving from important individuals in past experience, while resistance is the attempt to block memories that cause psychic pain from reaching consciousness. Therapy therefore involves working through the resistances and uncovering transference in an attempt to make the unconscious conscious (Bemporad, 1992; Corey, 1996).
One of the problems of psychoanalytic therapy is its time-consuming nature. Rosenberg (1985), for example, in describing “brief” psychoanalytic therapy, suggests up to 40 sessions. This type of therapy also lacks research that is sufficiently large and objective to indicate long term effectiveness (Bemporad, 1992).
Nevertheless, Kaplan & Sadock (1998) indicate that psychoanalytic therapy, while more time-consuming, is just as effective as cognitive-behavioural approaches in treating depression. More recently, Lothane (2004) has argued that psychoanalytical therapy still has an important contribution to make by using techniques of suggestion and influence. He also commends the Jungian technique of encouraging in clients the quality of creativity, by which he means the uncovering of the creative unconscious as expressed by poets and artists down the ages.

CHAPTER ONE INTRODUCTION: SPIRITUALITY AND DEPRESSION – A NEGLECTED DIMENSION
General Introduction
Definitions of concepts
Aim and rationale of the study
Ontology, epistemology and methodology
Design of the study
The researcher
The layout of the Study
Conclusion
CHAPTER TWO SPIRITUALITY: A FIELD OF GROWING IMPORTANCE IN PSYCHOLOGY
Introduction
The meaning of spirituality from different perspectives
Spirituality as an expression of the unconscious
Spiritual growth
Stages of spiritual growth and their facilitation by spiritual disciplines
Acknowledging spirituality in psychotherapy
Spirituality as part of the ecosystem
Definitions of spirituality in recent quantitative research
Components of spirituality in recent quantitative research
Conclusion
CHAPTER THREE DEPRESSION: A MULTI-FACETED PHENOMENON
Introduction
“Normal” depression
Adjustment disorder with depressed mood
Dysthymia
Major depression
Factors related to depression
Treatments and outcomes
The impact of postmodernism
Conclusion
CHAPTER FOUR SOCIAL CONSTRUCTIONISM: PEOPLE INTERACTING IN CONTEXT BY LANGUAGE
Introduction
Brief historical overview
Social constructionism: A definition
The family of ideas underlying social constructionism explored more fully
Social constructionism and personality
Social constructionism and reality
Social constructionism and language
Social constructionism and discourse
Social constructionism and ethics
Conclusion
CHAPTER FIVE RESEARCH METHODOLOGY: THE JOURNEY IS AS IMPORTANT AS THE DESTINATION
Introduction
The researcher’s site within qualitative research
Qualitative research as used in this study: Main features
Social constructionism, qualitative research and this study
Trustworthiness (dependability and credibility) of the research
Ethical considerations
Sampling and selection
Data collection
Data analysis
Conclusion
CHAPTER SIX MY STORIES OF THE PARTICIPANTS’ STORIES: ALLOWING THE VOICES OF ORDINARY (YET EXTRAORDINARY) PEOPLE TO BE HEARD
CHAPTER SEVEN A COMPARATIVE ANALYSIS: HARMONIZING THE VOICES